Closing the Cancer Data Gap: Development of the CARIFAS Tool for Cancer Risk Factor Surveillance in Uganda
Annet Nakaganda, Henry Wannume, Charles Ayo Akiya, Lynn Atuyambe, Jim Arinaitwe, Marianna Agaba, Charles Mondo, Nazarius Tumwesigye, Roy William Mayega, Samuel Etajak, Ronald Ssombwe, Phiona Bukirwa, Gerald MutungiPURPOSE
Cancer incidence is rising in Uganda. While some life-style risks are documented, key cancer drivers, including infections, environmental and occupational exposures remain inadequately measured. The aim of the study was to develop a standardized, scalable cancer risk factor surveillance tool (CARIFAS Tool) tailored for low- and middle-income countries.
METHODS
The CARIFAS Tool was developed between 2022 and 2024 based on the WHO STEPwise approach, a literature review, and a Delphi consensus process to ensure content and face validity. The process included three multi-sectoral harmonization workshops and a population-based cross-sectional survey conducted in Mayuge district (n = 240, ≥18 years). Data was analysed using STATA 15.
RESULTS
The tool introduces three key innovations: inclusion of reproductive, environmental, occupational, and infection-related cancer risk factors; localization of alcohol measures to improve contextual relevance; and adoption of the Alternative Healthy Eating Index to assess unhealthy diet. Prevalence estimates from the tool agree with existing literature: tobacco use (5.7%), alcohol use (10.2%), physical inactivity (15.3%), overweight (17.3%), and obesity (6.3%). 70% had unhealthy diet. 43.6% reported occupational exposures, and 12 % reported high to medium environmental exposures to diesel motor emissions, while 99.4% reported exposure to cooking/wood smoke. Reproductive risk indicators showed that 78.9% reported menarche above 12 years, 92.2% had their first birth below 25 years, the mean parity was 6 children per woman, 2.0% were nulliparous, 71.1% breastfed for 12–24 months, and 21.6% had used oral contraception. Infections findings included HIV (Male 1.4% and 2.9% in females), Hepatitis-B (Males is 0.45% and Females 1.05%), Hepatitis-C (male 4.7% and 1.0% in women), H. pylori (Males 17% and Females 18.4%), and HPV (17.6% among women). Importantly, this work led to the establishment of a multi-sectoral network and framework, including the Ministry of Health (MOH), Uganda Cancer Institute (UCI), Uganda Bureau of Statistics (UBOS), Makerere University (MAK), major hospitals, HCIVs, and Village Health Teams (VHTs), demonstrating feasibility for national scale-up.
CONCLUSION
The CARIFAS Tool is a feasible, context-appropriate, scalable approach to standardized cancer risk factor surveillance. With national integration, this model provides a practical pathway for strengthening cancer data systems in Uganda and other similar settings.